The Burden of Injury and Resources Availability for Emergency Care of Patients Presenting With Injury to Dar Es Salaam Regional Referral Hospitals

Abstract

Introduction: Emergency care for trauma patients is an important component of health care systems especially in low and middle income countries (LMIC), this is due to fact that these countries are facing huge trauma burden due to high level of injuries. However the capacity of many African health institutions in terms of equipments and skilled trained health personnel in trauma management is widely unexplored. Aim of the Study: To determine the burden of injury and resources availability for emergency care of patients presenting with injury to Dar es Salaam regional referral hospitals (DRRH), these are Amana, Mwananyamala and Temeke regional referral hospitals) Methods and Material: Was prospective observational cohort study done between the periods of October 2019 through December 2019 targeting all patients involved in any sort of injury presented in emergency units of Dar-es-salaam regional referral hospitals, (these are Amana, Mwananyamala and Temeke regional referral hospitals), with the accessible population being those who sustained any type of injury presenting to emergency department of any of the Dar-essalaam regional referral hospital. Patient’s demographics, injury characteristics, management strategies and disposition, reasons for referrals and the resources available on emergency care of patient with injury were recorded. The sampling technique was convenience simple random. The data was analyzed with STATAv13 (StataCorp, College Station, TX, USA) statistical software. Descriptive statistics, including means, standard deviations, medians, and ranges were calculated. Results: A total of 8197 patients were seen in DRRH. Of these patients, 2462 (30%) presented with trauma-related complaints. Among patients with trauma-related complaints, 471 (78.5%) were male, and the overall median age of 30 (interquartile range of 24–38) years. Motor vehicle accidents were the most common type of injury mechanism, accounting for 387(64.5%) complaints. External and extremities injuries were the two most frequent pattern of injuries, with a 355 (59%) and 155 (26%) cases respectively. Most of the patients 416 (69%) were discharged, 10 (2%) admitted to the ward and 174 (29%) of patients were referred to MNH. At Amana only 45% of the essential equipments for airway opening and protection, 43% for oxygenation and ventilation, and 55% for monitoring and treatment were available. While at Temeke only 27% of the essential equipments for airway opening and protection, 57% for oxygenation and ventilation, and 55% for monitoring and treatment only were available. The availability at Mwananyamala was, 54% for the essential equipments for airway opening and protection, 57% for oxygenation and ventilation, and 55% for monitoring and treatment. Only 8 (47%) out of 17 categories of the required trauma care supporting personnel were available in all three emergency departments of DRRH. None of the emergency departments was staffed with Emergency physician. Conclusion: Patients with trauma related complain impose a significant burden on emergency departments of DRRH. The burden is compounded with low resources availability in these hospitals, in terms of essentials equipments and supportive personnel/staff for emergency care of trauma patients.